不同麻醉方法对行腹腔镜前列腺癌根治术患者认知功能的影响

目的比较靶控输注丙泊酚瑞芬太尼全凭静脉麻醉、七氟醚和瑞芬太尼静吸复合麻醉及七氟醚加芬太尼复合腰硬联合麻醉对行腹腔镜前列腺癌根治术患者术后认知功能的影响。方法选择ASAⅠ～Ⅱ级，年龄60-75岁行择期腹腔镜前列腺癌根治术患者60例，随机分为靶控输注丙泊酚瑞芬太尼全凭静脉麻醉组（PR组），七氟醚和瑞芬太尼静吸麻醉组（SR组）和七氟醚加瑞芬太尼复合腰硬联合麻醉组（CS组），每组20例。在麻醉诱导前、术后1h、3h、5h和24h应用简易智力状态检查（MMS）测试方法评定其认知功能。结果三组患者各时间点MMS评分组间比较差异无统计学意义（P〉0．05）：三组患者在术后1h均较术前显著降低（P〈0．05），PR组、SR组和CS组分别有4例（20％）、有7例（35％），3例（15％）患者有明显的认知功能降低；术后3hPR组和SR组分别有2例（10％）和有3例（15％）MMS分值较低，CS组基本恢复至术前水平；术后5h和24h三组MMS评分恢复至术前水平。结论在腹腔镜前列腺癌根治术后均可引起一过性的术后认知功能障碍，三种麻醉方法的影响相似。

Effects of three anesthetic approaches on postoperative cognitive function in patients undergone laparoscopic radical prostatectomy

Objective To study the effect of three anesthetic approaches （target-controlled infusion of propofol combined with remifentanil, intravenous-inhalation combined anesthesia using sevoflurane and remifentanil, sevoflurane and fentanyl combined with CSEA） on postoperative cognitive function in patients undergone laparoscopic radical prostatectomy. Methods Sixty ASAⅠ-Ⅱ patients aged 60-75 years undergoing laparoscopic radical prostatectomy were randomly divided into three groups （n=20 each）： In group PR, patients received target-controlled infusion of propofol combined with remifentanil. In group SR, anesthesia was maintained using remifentanil in combination with sevoflurane. In group CS, sevoflurane and fentanyl combined with CSEA were performed. Cognitive function was evaluated before anesthesia, 1, 3, 5 and 24 hours postoperatively using mini-mental state. Resulta There were no significant difference in MMS score at different time among three groups. MMS scores decreased significantly at 1 h after operation in three groups. The percentage of the patients who developed postoperative cognitive dysfunction （POCD） in group PR, SR, CS were 20% （4 cases）, 35% （7 cases） and 15% （3 cases） respectively. At 3 hours postoperatively, low MMS scores developed in two patients from group PR and one patient from group SR, while MMS scores return to preoperative status in group CS. MMS scores all return to preoperative level in three groups at 5 hours and 24 hours postoperatively. Concluaiona Temporary postoperative cognitive dysfunction will develop after laparoscopic radical prostatectomy which is similar in three different methods of anesthesia.